This patient with a hx of ***CHF presents with acute shortness of breath and peripheral edema, most consistent with acute decompensated heart failure and concerning for cardiogenic shock. Likely etiology is medication non-compliance // dietary indiscretion // HTN // infection // fluid overload // anemia //alcohol intoxication // thyroid disease.*** I considered ACS as a possible etiology but think this less likely. EKG without overt evidence of acute ischemia. Other acute, emergent etiologies of shortness of breath are unlikely at this time.

Given tenuous systolic function and hypotension, plan includes starting ionotrope such as dobutamine +/- ionopressor (i.e. Dopamine, levophed). Will give O2; would like to avoid utilizing NIPPV or intubation due to tenuous preload status. Will require admission for acute management of ADHF.

Plan: labs, troponin, BNP, EKG, CXR, BUS, vasopressors, Cardiology consult***